title: Varied presentation of celiac disease in Pakistani adults.
abstract: The objective of this retrospective study was to evaluate presentation of celiac disease in adults. It included 77 patients, 41 (53.2%) males with median age 26 years and median body mass index of 18 (16 - 22) kg/m². Typical presentation with gastrointestinal symptoms was seen in 76.6%. Atypical presentation with extra intestinal complaints in 7.8% and silent presentation in 15.6%. Major symptoms were diarrhea in 64.9%, weight loss 36.4%, abdominal pain 35.1%, vomiting 32.5%, pallor 24.7%, and weakness 13%. Iron deficiency was documented in 20.8%, B12 deficiency in 9.1%, folic acid deficiency in 6.5% and vitamin D deficiency in 10.4%. Half of the patients had haemoglobin less than 11 g/dl. Osteoporosis and osteomalacia, hypothyroidism, diabetes and atrophic gastritis were seen in 2.6% each. Raised alanine aminotransferase was documented in 23.4%. Duodenal biopsy, done in 39 patients, revealed increased intraepithelial lymphocytes in 11, along with crypt hyperplasia in 3, partial villous atrophy in 15 and sub-total villous atrophy in 10. In conclusion, celiac disease in adults should be looked for in patients with chronic diarrhea or irritable bowel syndrome like symptoms, underweight, anaemic, or having nutritional deficiencies.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Karachi. drzabbas@gmail.com
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Sajjad
authors.initials: S
authors.lastname: Raza
authors.forename: Javed
authors.initials: J
authors.lastname: Yakoob
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Hasnain
authors.initials: H
authors.lastname: Shah
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D001284:Atrophy / Q000453:epidemiology / Q000209:etiology; D015992:Body Mass Index; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult